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Normal vaginal flora, disorders and application of probiotics in pregnancy

Abstract

Purpose

To assess the effectiveness of vaginal administration of the probiotic Lactobacillus rhamnosus BMX 54 in preventing the occurrence of abnormal vaginal flora and the alteration of parameters relevant to the progression of pregnancy.

Methods

Sixty pregnant women were assigned randomly to the untreated arm of the study (n = 30) or received (n = 30) vaginal application of one tablet containing Lactobacillus rhamnosus BMX 54, once a week for 12 weeks. Every 4 weeks (T0–T3), vaginal and cervical swabs were collected and pH, and quantity and quality of vaginal discharge measured as well as consistency, length and dilatation of cervix, and level of the presenting part of the foetus relative to interspinous diameter.

Results

In untreated women, there was a significant trend towards increase in the presence of pathogenic microorganisms in the vaginal and/or cervical swabs (p < 0.05), and in average pH values (p < 0.05), amount (p < 0.05) and “whiff test” positivity (p < 0.05) of vaginal discharge. Significant trend was also found for decrease in length (p < 0.0001) and increase in dilatation (p < 0.05) of cervix, as well as for lower position of the foetus (p < 0.0001). In the group treated with Lactobacillus rhamnosus BMX 54, none of these values significantly changed throughout the observation period, with the exception of cervical length that was significantly decreased at T3 (p < 0.01).

Conclusions

During pregnancy, vaginal administration of Lactobacillus rhamnosus BMX 54 is effective in preventing the development of abnormal vaginal microflora, lowering of the presenting part of the foetus and modifying cervical parameters that could represent risk factors of vulnerability to preterm delivery.

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References

  1. Witkin SS, Linhares IM, Giraldo P (2007) Bacterial flora of the female genital tract: function and immune regulation. Best Pract Res Clin Obstet Gynecol 21:347–354

    Article  Google Scholar 

  2. Fitzsimmons N, Berry DR (1994) Inhibition of Candida albicans by Lactobacillus acidophilus: evidence for the involvement of a peroxidase system. Microbios 80:125–133

    PubMed  CAS  Google Scholar 

  3. Hawes SE, Hillier SL, Benedetti J, Stevens CE, Koutsky LA, Wolner-Hanssen P (1996) Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis 174(5):1058–1063

    PubMed  Article  CAS  Google Scholar 

  4. Wilks M, Wiggins R, Whiley A, Hennessy E, Warwick S, Porter H, Corfield A, Millar M (2004) Identification and H(2)O(2) production of vaginal lactobacilli from pregnant women at high risk of preterm birth and relation with outcome. J Clin Microbiol 42:713–717

    PubMed  Article  CAS  Google Scholar 

  5. Sablon E, Contreras B, Vandamme E (2000) Antimicrobial peptides of lactic acid bacteria: mode of action, genetics and biosynthesis. Adv Biochem Eng Biotechnol 68:21–60

    PubMed  CAS  Google Scholar 

  6. Li J, Aroutcheva AA, Faro S, Chikindas ML (2005) Mode of action of lactocin 160, a bacteriocin from vaginal Lactobacillus rhamnosus. Infect Dis Obstet Gynecol 13:135–140

    PubMed  Article  CAS  Google Scholar 

  7. Reid G, Tieszer C, Lam D (1995) Influence of lactobacilli on the adhesion of Staphylococcus aureus and Candida albicans to fibers and epithelial cells. J Ind Microbiol 15:248–253

    PubMed  Article  CAS  Google Scholar 

  8. Heinemann C, Hylckama Vlieg JE, Janssen DB, Busscher HJ, van der Mei HC, Reid G (2000) Purification and characterization of a surface-binding protein from Lactobacillus fermentum RC-14 that inhibits adhesion of Enterococcus faecalis 1131. FEMS Microbiol Lett 190:177–180

    PubMed  Article  CAS  Google Scholar 

  9. Aroutcheva AA, Simoes JA, Faro S (2001) Antimicrobial protein produced by vaginal Lactobacillus acidophilus that inhibits Gardnerella vaginalis. Infect Dis Obstet Gynecol 9:33–39

    PubMed  Article  CAS  Google Scholar 

  10. Schwebke JR, Richey CM, Weiss HL (1999) Correlation of behaviors with microbiological changes in vaginal flora. J Infect Dis 180:1632–1636

    PubMed  Article  CAS  Google Scholar 

  11. Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M et al (2007) The prevalence of bacterial vaginosis in the United States, 2001–2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Trans Dis 34(11):864–869

    Article  Google Scholar 

  12. Koumans E, Lane S, Aubry R, DeMott K, Webster N, Levandowski B, Berman S, Markowitz L (2011) Evaluation of Syracuse Healthy Start’s program for abnormal flora management to reduce preterm birth among pregnant women. Mat Child Health J 15:1020–1028

    Article  Google Scholar 

  13. Riggs M, Klebanoff M, Nansel T, Zhang J, Schwebke J, Andrews W (2007) Longitudinal association between hormonal contraceptives and bacterial vaginosis in women of reproductive age. Sex Trans Dis 34:954–959

    CAS  Google Scholar 

  14. Denney JM, Culhane JF (2009) Bacterial vaginosis: a problematic infection from both a perinatal and neonatal perspective. Sem Fetal Neonatal Med 14:200–203

    Article  Google Scholar 

  15. Donders GGG, Bellen G, Rozeberga D (2011) Aerobic vaginitis in pregnancy. BJOG: Int J Obstet Gynecol 118:1163–1170

    Article  Google Scholar 

  16. Ehrström S, Daroczy K, Rylander E, Samuelsson C, Johannesson U, Anzén B, Påhlson C (2010) Lactic acid bacteria colonization and clinical outcome after probiotic supplementation in conventionally treated bacterial vaginosis and vulvovaginal candidiasis. Microb Infect 12:691–699

    Article  Google Scholar 

  17. Marcone V, Rocca G, Lichtner M, Calzolari E (2010) Long-term vaginal administration of Lactobacillus rhamnosus as a complementary approach to management of bacterial vaginosis. Int J Gynecol Obstet 110:223–226

    Article  Google Scholar 

  18. Rossi A, Rossi T, Bertini M, Caccia G (2010) The use of Lactobacillus rhamnosus in the therapy of bacterial vaginosis. Evaluation of clinical efficacy in a population of 40 women treated for 24-months. Arch Gynecol Obstet 281:1065–1069

    PubMed  Article  Google Scholar 

  19. Ya W, Reifer C, Miller LE (2010) Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study. Am J Obstet Gynecol 203:120

    PubMed  Article  Google Scholar 

  20. Donati L, Di Vico A, Nucci M, Quagliozzi L, Spagnuolo T, Labianca A, Bracaglia M, Ianniello F, Caruso A, Paradisi G (2010) Vaginal microbial flora and outcome of pregnancy. Arch Gynecol Obstet 281(4):589–600

    PubMed  Article  Google Scholar 

  21. Klebanoff MA, Hauth JC, MacPherson CA, Carey JC, Heine RP, Wapner RJ et al (2004) Time course of the regression of asymptomatic bacterial vaginosis in pregnancy with and without treatment. Am J Obstet Gynecol 190(2):363–370

    PubMed  Article  Google Scholar 

  22. Hay PE, Lamont RF, Taylor-Robinson D, Morgan DJ, Ison C, Pearson J (1994) Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. Br Med J 308:295–298

    Article  CAS  Google Scholar 

  23. Carey JC, Klebanoff MA (2005) Is a change in the vaginal flora associated with an increased risk of preterm birth? Am J Obstet Gynecol 192(4):1341–1346

    PubMed  Article  Google Scholar 

  24. Donders GG, Van Calsteren K, Bellen G, Reybrouck R, Van den Bosch T, Riphagen I, Van Lierde S (2009) Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG: Int J Obstet Gynecol 116:1315–1324

    Article  CAS  Google Scholar 

  25. Leitich H, Kiss H (2007) Asymptomatic bacterial vaginosis and intermediate flora as risk factors for adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 21(3):375–390

    PubMed  Article  Google Scholar 

  26. Donders GG, Van Calsteren C, Bellen G, Reybrouck R, Van den Bosch T, Riphagen I, Van Lierde S (2010) Association between abnormal vaginal flora and cervical length as risk factors for preterm birth. Ultrasound Obstet Gynecol 2010 Jan 26 (epub ahead of print)

  27. Mancuso MS, Figueroa D, Szychowski JM, Paden MM, Owen J (2011) Midtrimester bacterial vaginosis and cervical length in women at risk for preterm birth. Am J Obstet Gynecol 204:342

    PubMed  Article  Google Scholar 

  28. Usui R, Ohkuchi S, Matsubara S, Izumi A, Watanabe T, Suzuki M, Minakami H (2000) Vaginal lactobacilli and preterm birth. J Perinat Med 30:458–466

    Article  Google Scholar 

  29. Hay PE (2004) Bacterial vaginosis and miscarriage. Curr Opin Infect Dis 17(1):41–44

    PubMed  Article  Google Scholar 

  30. Amsel R, Totten PA, Spegiel CA (1983) Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 74:14–22

    PubMed  Article  CAS  Google Scholar 

  31. Pararas MV, Skevaki CL, Kafetzis DA (2006) Preterm birth due to maternal infection: Causative pathogens and modes of prevention. Eur J Clin Microbiol Infect Dis 25(9):562–569

    PubMed  Article  CAS  Google Scholar 

  32. Simhan HN, Caritis SN, Krohn MA, Martinez de Teada B, Landers DV, Hillier SL (2003) Decreased cervical proinflammatory cytokines permit subsequent upper genital tract infection during pregnancy. Am J Obstet Gynecol 189:560–567

    PubMed  Article  CAS  Google Scholar 

  33. Waters TP, Denney JM, Mathew L, Goldenberg RL, Culhane JF (2008) Longitudinal trajectory of bacterial vaginosis during pregnancy. Am J Obstet Gynecol 199:431–435

    PubMed  Article  Google Scholar 

  34. Othman M, Alfirevic Z, Neilson JP (2007) Probiotics for preventing preterm labour. Cochrane Database of Systematic Reviews: Reviews 2007 Issue 1. Wiley, Chichester, doi:10.1002/14651858.CD005941.pub2

  35. Larsson PG, Stray-Pedersen B, Ryttig K, Larsen S (2008) Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebo-controlled study. BMC Women’s Health 8:3

    PubMed  Article  Google Scholar 

  36. Martinez RCR, Franceschini SA, Patta MC, Quintana SM, Gomes BC, De Martinis ECP, Reid G (2009) Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial. Can J Microbiol 55:133–138

    PubMed  Article  CAS  Google Scholar 

  37. Simmons LE, Rubens CE, Darmstadt GL, Gravett MG (2010) Preventing preterm birth and neonatal mortality: exploring the epidemiology, causes, and interventions. Semin Perinatol 34(6):408–415

    PubMed  Article  Google Scholar 

  38. Matijevic R, Grgic O, Knezevic M (2010) Vaginal pH versus cervical length in the midtrimester as screening predictors of preterm labor in a low-risk population. Int J Gynecol Obstet 111:41–44

    Article  Google Scholar 

  39. Hoyme UB, Saling E (2004) Efficient prematurity prevention is possible by pH-self measurement and immediate therapy of threatening ascending infection. Eur J Obstet Gynecol Reprod Biol 115(2):148–153

    PubMed  Article  CAS  Google Scholar 

  40. Lamont RF, Taylor D (2010) The role of bacterial vaginosis, aerobic vaginitis, abnormal vaginal flora and the risk of preterm birth. BJOG 117(1):119–120

    PubMed  CAS  Google Scholar 

  41. Hoyme UB, Huebner J (2010) Prevention of preterm birth is possible by vaginal pH screening, early diagnosis of bacterial vaginosis or abnormal vaginal flora and treatment. Gynecol Obstet Invest 70(4):286–290

    PubMed  Article  CAS  Google Scholar 

  42. Saling E (2011) Problems in prevention of preterm birth–regrettable contradictions. A special comment from the Founder of the Journal of Perinatal Medicine. J Perinat Med 39(3):223–225

    PubMed  Article  Google Scholar 

  43. Donders GGG, Vereecken A, Bosmans E, Dekeersmaecker A, Van Bulck B, Spitz B (2000) Pathogenesis of abnormal vaginal bacterial flora. Am J Obstet Gynecol 182:872–878

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Nemanja Stojanović.

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Stojanović, N., Plećaš, D. & Plešinac, S. Normal vaginal flora, disorders and application of probiotics in pregnancy. Arch Gynecol Obstet 286, 325–332 (2012). https://doi.org/10.1007/s00404-012-2293-7

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  • DOI: https://doi.org/10.1007/s00404-012-2293-7

Keywords

  • Pregnancy
  • Lactobacillus rhamnosus BMX 54
  • Abnormal vaginal microflora
  • Cervical competence
  • Probiotic treatment